Individual
DIANE BOURLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6307
(813) 870-4000
Mailing address
PO BOX 10030, DAYTONA BEACH, FL 32120-0030
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS7987
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225207
AMERIGROUP
FL
05
—
257467500
—
FL
01
—
49154
BLUE CROSS OF FLORIDA
FL
Enumeration date
07/01/2006
Last updated
07/31/2009
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